Relative Chemo-, Hormonal, and Immunosensitivity

Abstract

Familiarity with the relative chemo-, hormonal, and immunosensitivity of metastatic neoplasms is indispensable for surgeons managing spinal metastases. Although the spine surgeon may not necessarily be dictating the specifics of adjuvant treatment, it is imperative that he/she understands the anticipated caliber, timeframe, and durability of response, as well as the patient’s projected survival, in order to make an informed decision regarding management of the patient’s spinal lesions. Sensitivity to systemic therapy is a dynamic concept, which evolves over the course of the disease and can vary between different lesions and different time points. Appropriate indications, timing, and technique of biopsy are crucial to determining sensitivity and guiding treatment. The availability or lack thereof of effective systemic therapeutic options can alter the goals and timing of surgery. We discuss the general concepts of sensitivity, biopsy, and response assessment, as well as specific concepts in sensitivity to therapy in the cancer subtypes commonly encountered with spinal metastases.